Worries over Budget Cuts for Teen Pregnancy Prevention

WASHINGTON -- Fallout continues from the Trump administration's recent announcement that it will cut short funding for teen pregnancy prevention programs (TPPPs), ending program funding in June 2018 instead of 2020.

"Ending what was intended to be 5-year TPPP grants 2 years early is highly disruptive to ongoing work in localities across the country," heads of public health departments in 20 large U.S. cities wrote in a July 25th letter to Health and Human Services (HHS) Secretary Tom Price, MD. "These cuts will negatively affect the lives of young people currently participating in these programs, and will mean fewer project jobs, fewer trained professionals, and reduced community partnerships. Further, researchers will be unable to analyze data they have spent years collecting, and it will be incredibly difficult to draw any conclusions about what pieces of these programs work best and which are less effective at preventing unwanted teen pregnancy."

The HHS announcement came in the form of a letter sent to grantees of the program, which the Obama administration launched in 2010. The early cutoff means the programs will receive a total of $200 million less than they expected, according to media reports. HHS did not respond to a request for comment on this story.

Big-city mayors were not the only group expressing concern about the funding cut. "These deep and disruptive cuts will absolutely negatively impact young people's reproductive health and autonomy -- by design," said Sarah Christopherson, policy advocacy director at the National Women's Health Network here, in an email. "They are the natural, devastating result of Donald Trump's decision to fill key posts in his administration with people who not only oppose the programs they're in charge of, they also deny the underlying science about comprehensive sex education and contraception."

Cuts Seen as a 'Step Backward'

The American College of Obstetricians and Gynecologists called the cuts "a step backward for ensuring healthy moms and healthy babies," adding, "This program, and others, provide vital research and programming that successfully brought our nation to an all-time low rate of teen pregnancies -- progress we cannot afford to jeopardize."

Brett Worly, MD, an assistant professor of ob/gyn at The Ohio State University in Columbus, expressed concern about the effects that the cuts would have on Planned Parenthood, which receives some of the grant funding. "A substantial decrease in Planned Parenthood funding could mean that these patients no longer get the contraception, immunizations, and cancer screenings they need," he said in an email. "Teen pregnancy rates may in turn begin to increase, with a large percentage of these being unplanned pregnancies, and a larger number of abortions or terminations of pregnancy resulting."

"It worries me to have those kinds of programs cut because teenagers are impulsive and teen pregnancy is a problem," said Marjorie Greenfield, MD, professor of ob/gyn at Case Western Reserve University in Cleveland. She noted that the downturn in teen pregnancy rates is due in part to better availability of long-acting reversible contraceptives (LARCs) such as etonogestrel implants, IUDs, and Depo-Provera, since they mean that teenagers don't have to worry about birth control each time they have sex.

Good Results in Colorado

Several years' experience in Colorado with promotion of LARCs resulting in a drastically reduced abortion rate "is an excellent example demonstrating the effectiveness of pregnancy prevention," said James Liu, MD, chair of ob/gyn at University Hospitals Cleveland, in an email. "This is not 'fake news'. Those in government who choose to ignore facts will repeat the mistakes of the past. Teens are not going to practice abstinence overnight and this is also another biological fact."

The cuts will "have a disheartening impact on what we have achieved" in terms of preventing teen pregnancies, wrote Christina Enzmann, MD, an ob/gyn at the University of Maryland School of Medicine, in Baltimore, in an email. "This will unfortunately set us back decades."

Enzmann's colleague Katrina Mark, MD, questioned the ideological nature of the cuts. "Given the success of these programs in decreasing the teen pregnancy rate, it seems inconceivable to me that there is any long-term, non-political benefit of decreasing their funding," she wrote in an email.

HHS Confirmation Vote Affected

The cuts also came up during an Aug. 1 confirmation hearing for Brett Giroir, MD, a pediatrician nominated for an assistant secretary of health position that deals with TPPP funding. "I'm very concerned by the actions taken ... under this administration," Sen. Patty Murray (D-Wash.), ranking member of the Senate Health, Education, Labor, & Pensions (HELP) Committee, said to Giroir in reference to the cuts. "These are competitive, evidence-based programs; they have reached hundreds of thousands of teens nationwide." She noted that she and several dozen other senators wrote to Price asking for information on the funding cut, but had not heard back.

"If you are confirmed, do you commit to providing information to me and other concerned senators about why the administration is trying to terminate these grants when they are meant to continue for an additional 2 years and further, what you plan to do regarding the teen pregnancy prevention program?" she asked.

"As a pediatrician, I share your concern about teen pregnancy," Giroir said. "You have my commitment to work with you and provide information ... As you know, the budgetary justification from the administration stated that the programs [sic] in the teen pregnancy program did not significantly influence the drop in [the] teen pregnancy rate. That is all I know about the rationale, and -- "

Murray interrupted him. "Do you believe that?"

"Well, I have not been able to review the evidence or the assessments that were made in order to achieve that conclusion," said Giroir. "The only information I have is the public review -- which was very well done -- in 2015 that looked at the first 5 years of the program. The program was evidence-based; it was community-based. There were many programs that were successful; there were many programs that could not be repeated, but even the lack of repeatability of a program is information we need to know. So we need to know what works and does not work. Once I have more information, I look forward to engaging in this discussion vigorously, and [if I am confirmed] this is very high on my agenda."

Giroir's answers on these and similar questions apparently didn't satisfy Senate Democrats; although the other four HHS nominees testifying at the hearing were confirmed by the Senate on Aug. 3 in a voice vote, Giroir's nomination was held up for a roll call vote to be held after the Senate returns in September from its August recess. "After carefully reviewing his qualifications, I am unconvinced Dr. Giroir would be willing to stand up to this administration's ideological attacks on women in a key leadership role at HHS," Murray told Kaiser Health News.

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